The Menopause Blind Spot: What 13 Years of Treating Musculoskeletal Pain Didn't Teach Me

Could your stubborn shoulder pain, aching hips, or persistent back pain have more to do with hormones than you think?

I've been a chiropractor for over 13 years. My expertise is the musculoskeletal system. Muscles, joints, tendons, ligaments, movement, and the frustrating injuries that keep people from doing what they love.

Day in and day out, I treat low back pain, neck pain, headaches, shoulder injuries, hip and glute pain, plantar fasciitis, and just about everything in between.

I would like to think I've gotten pretty good at it.

But recently, my wife opened my eyes to a massive blind spot in how I've been treating women for more than a decade.

And once I saw it, I couldn't unsee it.

My Wife, My Business Partner, and Apparently My Continuing Education

Less than a year ago, my wife Alyson, a family practice nurse practitioner specializing in functional medicine and women's hormone health, joined me in practice. We rebranded our clinic to Synergy Health, combining my background in chiropractic and sports rehabilitation with her expertise in functional medicine.

I knew bringing her into the practice would expand what we could offer our patients.

What I didn't anticipate was how much she would challenge the way I thought about my own patients.

One day, Alyson started explaining the relationship between declining estrogen levels and musculoskeletal pain during perimenopause and menopause.

She explained that estrogen receptors aren't just found in reproductive tissues. They're present throughout the body, including in muscles, tendons, ligaments, cartilage, and bone.

Estrogen does a whole lot more than regulate menstrual cycles.

It influences inflammation, collagen metabolism, muscle maintenance, tissue repair, and bone remodeling. As estrogen levels fluctuate and eventually decline, those processes can change. Tendons may become less resilient, joints may become more painful or stiff, and maintaining muscle and bone becomes increasingly challenging.

Essentially, the hormonal environment in which these tissues have functioned for decades is changing.

And sometimes those tissues aren't particularly happy about it.

It's not quite as simple as empty estrogen receptors screaming for attention, but that's how I initially pictured it. The signals that help regulate tissue maintenance, inflammation, and recovery are changing, and the musculoskeletal system can feel the consequences.

I remember thinking, How in the world have I been treating musculoskeletal conditions for 13 years and never really considered this?

Then came the patient who smacked me right in the back of the head with that realization.

The Marathon Runner Who Couldn't Walk

A woman in her mid-50s came to see me with debilitating low back pain.

She was an avid runner. Loved marathons. Loved being active.

And now she could barely walk comfortably, let alone run.

For approximately three weeks, we threw just about everything in my clinical toolbox at her pain.

Graston Technique. Cupping. Dry needling. Spinal manipulation. Core exercises. Stretching. Rehabilitation.

The works.

And she barely improved.

Now, not every patient responds to treatment on the same timeline. I understand that. But after treating thousands of musculoskeletal conditions over the years, you develop a pretty good sense of when someone should be making progress.

She wasn't.

Something was missing.

With my newfound appreciation for the hormonal component of musculoskeletal pain, I encouraged her to schedule an appointment with Alyson.

After evaluating her, Alyson prescribed transdermal estradiol, commonly known as an estrogen patch.

About a week and a half later, she was back to running, nearly pain-free.

I was blown away.

Three weeks of manual therapy and rehabilitation had produced minimal improvement. Then, following the addition of hormone therapy, her pain and function changed dramatically.

Now, I can't scientifically prove the estrogen patch was solely responsible. We had already been working on her musculoskeletal system, and recovery is rarely attributable to just one intervention.

But the timing and magnitude of her improvement certainly got my attention.

And here's the funniest part of the entire story.

She thinks I fixed her.

She gives me all the credit. Apparently, three weeks of Graston, cupping, and chiropractic care finally worked their magic.

Alyson and I have a slightly different interpretation.

But you know what? She can feel great and be wrong.

I'm just thrilled she's running again.

The Research That Connected the Dots

Recently, I listened to episode 87 of Hello Hormones with Dr. Carrie Jones, featuring chiropractor and menopause educator Dr. Fiona Lovely.

The episode discussed something that should be getting far more attention in healthcare: the musculoskeletal syndrome of menopause.

In 2024, orthopedic surgeon Dr. Vonda Wright and her colleagues published a paper in the journal Climacteric introducing this term to describe the collection of musculoskeletal changes associated with declining estrogen.

Their review estimates that more than 70% of women experience musculoskeletal symptoms during the transition from perimenopause into postmenopause, with approximately 25% experiencing symptoms severe enough to be disabling.

Let that sink in.

We're talking about a tremendous number of women experiencing pain, stiffness, weakness, or declining physical function during this stage of life.

And how often are they told it's just aging?

Or arthritis?

Or that they need to stretch more?

Or, my personal favorite as a sports medicine chiropractor, that they just need to strengthen their glutes?

Don't get me wrong. Sometimes they absolutely do need to strengthen their glutes.

But what if we're overlooking the physiological environment those muscles and tendons are trying to function in?

The research discusses joint pain, muscle loss, declining bone density, and progression of osteoarthritis. Researchers are also investigating how hormonal changes may contribute to tendon problems and other soft-tissue conditions.

This doesn't mean every case of frozen shoulder, plantar fasciitis, or gluteal tendinopathy is caused by menopause. It means hormonal changes deserve a place in the conversation, particularly when symptoms appear during midlife without a clear injury or aren't responding as expected.

For me, that was a significant shift in perspective.

Now I'm Looking at My Patients Differently

Once Alyson opened my eyes to this connection, I started mentally reviewing years of patients.

The women with persistent hip pain.

The shoulders that just wouldn't settle down.

The recurring plantar fasciitis.

The tendon problems that seemed disproportionately stubborn despite appropriate rehabilitation.

How many of those patients had an underlying hormonal component we never investigated?

I obviously can't go back and answer that question.

But I can change how I approach the patients sitting in front of me today.

As I'm writing this, I'm treating a very active woman in her mid-60s who has been struggling with gluteal and hamstring tendinopathy, biceps tendinosis, neck pain, and headaches.

She's also a grandmother who wants to be able to keep up with her toddler grandchildren.

Instead, she's been sidelined by pain.

We've been battling these issues on and off for months.

And while I still believe there is tremendous value in addressing her strength, mobility, tendon loading, and mechanical dysfunction, I'm increasingly convinced we're missing another piece of the puzzle.

I suspect a visit with Alyson to evaluate her hormonal health may offer more insight than another ten visits with me doing the same things we've already tried.

That doesn't automatically mean she needs hormone therapy. At her age, the timing of menopause, medical history, cardiovascular risk, and other considerations matter when determining whether systemic hormones are appropriate.

But it absolutely means we should be asking better questions.

Another patient I'm currently treating is a woman in her mid-40s with severe shoulder tendinopathy.

Her pain has become so significant that she struggles to brush her teeth without supporting her affected arm.

Forget recreational activities. She's having difficulty with basic daily tasks, let alone keeping up with the demands of being an active mom.

We are working on her shoulder with Graston Technique, dry needling, progressive tendon loading, and mobility exercises.

But now I'm also interested in what may be happening hormonally.

Could perimenopause be contributing to her symptoms or affecting her recovery?

Possibly.

And if a hormonal evaluation identifies an issue worth addressing, I'm excited to see what happens when we combine appropriate medical management with targeted musculoskeletal rehabilitation.

Dare I say this approach might be a little more synergistic?

Sorry. I couldn't help myself.

I'll share updates as these cases progress, while respecting patient privacy, because I think there is tremendous value in understanding what happens when we stop treating different systems of the body as though they operate independently.

Does This Mean Hormones Are the Answer to Every Ache and Pain?

Absolutely not.

And I think that's an important distinction.

Musculoskeletal pain is complicated. Mechanical loading, injury history, sleep, stress, inflammation, physical activity, nutrition, and many other factors influence how our bodies feel and recover.

Hormones are another piece of that puzzle.

The emerging research is compelling, but we still need stronger clinical trials to understand exactly which musculoskeletal conditions respond to hormone therapy, which women benefit most, and how best to combine medical treatment with rehabilitation.

Hormone replacement therapy also isn't appropriate for everyone, and treatment decisions should be individualized.

I'm certainly not abandoning Graston, dry needling, spinal manipulation, or exercise rehabilitation.

Those interventions still have an important place in helping people move and feel better.

What I'm abandoning is the assumption that every stubborn musculoskeletal problem can be solved by addressing only the muscles and joints.

Sometimes we need to look beyond the area that hurts.

Women Deserve Better Than "It's Just Aging"

Here's what frustrates me most about all of this.

Women have been experiencing these symptoms for generations.

They've been told to accept the stiffness, the aching joints, the declining strength, and the loss of physical function as an inevitable part of getting older.

And in many cases, they've simply pushed through.

Or stopped doing the activities they love.

Or accepted a lower quality of life because nobody offered another explanation.

The research on estrogen and musculoskeletal tissue isn't entirely new. What's encouraging is that researchers and clinicians like Dr. Vonda Wright, Dr. Fiona Lovely, and many others are bringing these connections into mainstream conversations about women's health.

And it's about time.

I also have to give Alyson credit. Bringing her expertise into our practice has made me a better clinician by forcing me to recognize what I didn't know.

After more than 13 years of practice, that's a pretty valuable lesson.

The biggest takeaway isn't that every woman with joint pain needs hormones. It's that every woman deserves a provider willing to consider the whole picture.

If you're in your 40s, 50s, or 60s and suddenly dealing with persistent shoulder pain, aching hips, recurring tendon problems, or stiffness that doesn't seem to make sense, don't automatically dismiss it as aging.

And if you're already doing the stretching, strengthening, physical therapy, or chiropractic care without making the progress you'd expect, it may be worth having a conversation about your hormonal health.

At Synergy Health, that's exactly why we've brought chiropractic, sports rehabilitation, and functional medicine together.

Because sometimes the missing piece isn't another exercise, another adjustment, or another treatment.

Sometimes it's recognizing a connection we weren't looking for.

And sometimes, if you're lucky, your wife is the one who points it out.

Research & Further Listening

• Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024;27(5):466–472. Read the research on PubMed.

• Hello Hormones with Dr. Carrie Jones, Episode 87: Fiona Lovely: The Perimenopause Symptoms Women Are Still Being Told to Ignore. October 13, 2026. Listen on Apple Podcasts.

Brock Vosberg, DC

Co-Founder of Synergy Health | Chiropractic & Sports Rehabilitation

Synergy Health — Johnston, Iowa

This article is educational and reflects clinical observations, not proof of treatment effectiveness. Patient experiences are individual, and treatment recommendations should be based on a comprehensive evaluation.